As ambulance service has become more complex and expensive, small local ambulance companies are struggling to stay in business. These days, operating a successful ambulance requires a high call volume and or advanced life support service.

In small towns like Weatherly and Nesquehoning, the amount the ambulance gets for a call often doesn’t cover the cost of personnel.

Weatherly announced earlier this year that they are bleeding cash and may not be able to operate past the middle of next year. Another company has pledged to fill the gap, but they are stationed 20 miles away.

“It was a lot easier to get an ambulance back in the day,” says Gary Williams, director of the Carbon County Communications Center.

In Carbon County, Lansford, Penn Forest and most recently, Nesquehoning have decided to close their doors. Another ALS company, Regional Critical Care, combined with Advanced Medical Transport Systems in Pottsville.

Throughout the Eastern Pennsylvania region only 10 of 147 of all EMS providers, including basic and advanced life support as well as medical helicopters have shut down in the last five years.

Cost of personnel

One of the reasons that small rural ambulance companies were able to survive in the past was they were primarily staffed by volunteers.

Nesquehoning closed because while they had a dedicated group of volunteers, they were no longer able to keep it going.

Weatherly has paid staff around the clock, but with payroll of about $13,000 per month, they are unable to cover the cost.

Where have the volunteers gone? It could be a combination of increased demands on EMTs and social changes.

Williams said he recalled about 30 years ago when every ambulance company was staffed by volunteers.

John Kloss, executive director of the Eastern Pennsylvania EMS Council, suggested it may have something to do with the fact that there are more households with two working parents.

“We would have moms who would show up and watch the kids while you went out on emergency calls. So much has changed there,” Kloss said.

Joni Gestl, administrator for Lehighton Ambulance, said the testing that EMTs must now complete is more difficult than when she started out in the business, and more expensive. And it doesn’t take much more training to become an actual nurse.

“Would you like a volunteer nurse who does it twice a week, six times a month? I don’t know if I would,” Gestl said.

Reimbursements

The cost of running an ambulance goes up each year. Operating an Advanced Life Support rig costs about $350,000 per year. If a company can’t afford to go ALS, every time there is a life-threatening call, they have to split the reimbursement with and ALS company. Companies have to weigh whether they can afford the ALS service.

Ambulance companies seek grants and hold membership drives which help somewhat, but the vast majority of their revenue comes from insurance reimbursements.

Government programs like Medicare and Medicaid have a set amount they will pay back. Oftentimes, it doesn’t cover the cost of the call. For managed Medicaid, the cost is $120 per ambulance ride. If a company doesn’t have a large volume of calls, that could be a loss.

“In a slower area, the cost per hour may be $175. If you have an hour or two tied up in a call, you may be in the hole before you get back to your building,” Kloss said.

In the past, insurance companies wouldn’t even send the money to the ambulance companies. They would reimburse patients, and the ambulance would bill them for the cost. Legislation allowing ambulances to be paid directly has helped, Kloss said.

Gestl said she is also optimistic about a new law that allows companies to charge patients who are treated by an ambulance at home, but don’t get transported to the hospital. But reimbursements are still a challenge.

“Some patients don’t have insurance, so a lot of stuff, you can’t even get reimbursed,” she said.

Consolidation

Regional police departments are becoming more common. And that trend may soon extend to EMS service.

With the increased costs, the amount of calls needed to justify an ambulance service have increased.

It takes about 1,000 calls per year for a basic life support ambulance to be viable. Carbon County has more than 15,000 EMS calls per year, but they are not evenly divided.

Kloss says he doesn’t think consolidation means slower service. In many cases, ambulance companies can partner with existing fire companies to station a rig, or build a new building.

When a small ambulance corps is unable to provide a driver and EMT, 911 dispatchers will turn to another company which has a truck available. The response time is often longer than it would be for a local company.

One possible future for ambulance coverage is that you could see hospitals buying more ambulance companies. That recently happened in Hazleton with APTS and Lehigh Valley Health Network.

Lehigh Valley Health Network is starting a pilot program in the valley where an ambulance crew will treat congestive heart failure patients at their home.

“If they can keep you at home and keep you healthy, that’s the goal, and that’s what we’re starting to see in this area,” Kloss said.